MEDICARE: MARJORIE ANN GLEASON P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0014384	CO
2	225100000X	Physical Therapist	27403	FL

General Provider Information

NPI Number	:	1639431752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJORIE ANN GLEASON P.T.

Provider Business Mailing Address
First Line	:	3055 ROSLYN ST UNIT 110
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-3324
Country	:	US
Telephone Number	:	720-553-2712
Fax Number	:

Provider Business Practice Location Address
First Line	:	3055 ROSLYN ST UNIT 110
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-3324
Country	:	US
Telephone Number	:	720-553-2712
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2012
Last Update Date	:	03/25/2020

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